Outside Business Activities

* Are you currently engaged in any other business or being compensated in any way, other than by Regal?

Yes (Includes any insurance business)

No

* How many different Outside Business Activities do you have?

* Business Name

* Address

* City

* State

* Zip

* Address

* When did you become affiliated with this activity?

Number of Hours spent on a weekly basis

* Please describe your duties relating to this business activity

* Amount of Compensation on an average monhtly basis?

* This business is aware that I am a representative/employee of Regal Securities?

Yes

No

By entering in your name below you are stating that you will notify Regal Securities in writing if there are any changes to your outside activities

* First Name :
* Last Name :

* Please enter today's date

OBA